Jerry G. Jones

Munchausen syndrome by proxy

Munchausen syndrome by proxy is a form of child abuse in which a disorder of the child is fabricated by a parent. Although often considered rare, it may have been overlooked frequently in the past. The reported cases of children with Munchausen syndrome by proxy range in age from infancy to 8 years. Their illnesses consist of fabricated histories, inflicted physical findings, altered laboratory specimens, and induced disorders. The perpetrator usually is the childs mother, who may have Munchausen syndrome. Consequences of the syndrome may include painful tests, frequent hospitalizations, potentially harmful treatment, and death. The diagnosis can be made when medical and social histories are characteristic of the syndrome and clinical findings are absent, suggestive of induced illness, or resolve upon separation of the child and parent. Suspicion of the syndrome should be discussed with the family once the safety of the child is insured, and the case should be reported under the child abuse reporting law of the state. Social, family, and medical histories must be obtained and verified, and court intervention should be considered. Four patients who illustrate typical features of the syndrome are described.

The Child Accident Repeater A Review

The child accident repeater is defined as one who has at least three accidents that come to medical attention within a year. The accident situation has features in common with those of the child who has a single accident through simple bad luck, but other factors predispose him to repeated injury. In the child who has a susceptible personality, a tendency for accident repetition may be due to a breakdown in adjustment to a stressful environment. Prevention of repeat accidents should involve the usual measures considered appropriate for all children as well as an attempt to provide treatment of significant maladjustment and modification of a stressful environment.

Compliance with Pediatric Therapy A Selective Review and Recommendations

The problem of compliance with treatment is largely ignored in the major pediatric textbooks at the present time. However, the physicians responsibility should include a concern for the practicality of therapy and its acceptance by both parents and children. The subject of com pliance as related to pediatrics is selectively reviewed, and likely ways the physician can promote compliance are provided.

Use of optical glass binocular magnifiers in the examination of sexually abused children

Abstract A pilot survey designed to determine attitudes toward magnification and optical glass binocular magnifiers was administered to resident physicians for whom evaluation of sexually abused children was part of their training program. Approximately two-thirds of those who had used the instruments considered them to be helpful, easy to use, and a source of magnification they would recommend for future practice settings.

Residents' attitudes toward the legal system and court testimony in child abuse

Resident physicians contacts with the legal system during management of abused children may influence their attitudes, which were evaluated in a pilot survey completed by 42 pediatric and medicine/pediatric residents. Although negative attitudes toward attorneys were common, almost all of the residents considered general and hearing-specific legal training to be a legitimate part of their residency program. They reported lower levels of stress of court testimony than expected by the authors. Most who had testified in court believed their testimony had been needed and helpful, but all who believed their testimony had been a waste of time were senior-level residents. Although most residents believed the laws and courts usually work for protecting children, only 8 of the 20 residents who had previously testified in court responded affirmatively, and none of the 10 senior residents who had previously testified held this belief. The disillusionment of senior-level residents appeared to affect attitudes toward patient care less than expected, in that 90% of those who planned to enter private practice indicated they would perform physical abuse evaluations and 70% planned to perform sexual abuse evaluations. Only one resident who did not expect to perform the evaluations gave as a reason the prospect of having to testify in court.